As the name suggests, bunions are [toes turned out, the diagnosis is named after the clinical symptom, commonly known as foot orphan, big foot bone. As urbanization accelerates, people’s lives improve and all kinds of shoes appear, the number of bunion cases is increasing day by day. Less than the average number of patients with bunions are seen because the disease has affected the daily life of these people. Patients usually complain first of all of pain and difficulty walking. The second is that they cannot buy shoes that fit their feet in the market. The second is: unsightly appearance of the foot. The pain is usually concentrated on: [Medial toe: localized redness and swelling, hypertrophy. Sole of the foot: under the 2nd and 3rd metatarsal heads. lateral little toe: localized redness, swelling, and hypertrophy. Foot shape: forefoot widening, [toe riding on the 2nd toe, or with 2, 3, or 4 toe flexion deformity. Some patients may have decreased medial longitudinal arch of the foot. Plantar: There is callus formation below the 2nd, 3rd, and 4th metatarsal heads. In addition, other toe deformities may be combined, such as hammertoe deformity of the 2nd, 3rd, and 4th toes. The anatomy of a bunion is described as: [Toe valgus, or with internal or external rotation, riding across with the 2nd toe. 1st metatarsal inversion with external rotation (mostly), or internal rotation with elevation of the metatarsal head. Dislocation of the seed metatarsal joint with contracture of the medial capsule of the 1st metatarsophalangeal joint. Or with laxity of the 1st metatarsal a joint, decreased medial longitudinal arch of the foot, etc. Causes of foot pain: The foot deformity produces biomechanical changes in the foot when walking. The area of discomfort or pain that is restricted should be [the medial edge of the toe, followed by the plantar or lateral edge of the foot. With a widened forefoot, the width of the shoe we buy off the shelf is fixed, which increases the friction between the upper and the [medial toe or lateral little toe, and in order to almost relieve this excessive friction, the body itself produces bursae to eliminate the increased friction. The bunion disease process does not end there. This excessive pressure and friction can cause pain. All people have a certain habit of walking normally with more or less external deviation of the foot, which is directly related to the hip joint. During the propulsion period of normal walking, the forefoot is normally rotated forward so that the force is transmitted to the ground through the 1st metatarsal. As the bunion gradually increases, the 1st metatarsal inversion increases and the metatarsal head is elevated. The first metatarsal loses its original lever-conducting role, and the patient’s forefoot fails to rotate forward during the propulsion period. In order to obtain sufficient forward momentum, the weight-bearing on the lateral edge of the foot increases to compensate for the lack of conduction caused by the inversion and elevation of the first metatarsal. Over time, a hypertrophic callus forms on the lateral edge of the foot, which in turn causes a greater concentration of stress on the plantar aspect of the foot and produces pain. Treatment includes conservative and surgical treatment Mild cases can be treated conservatively by wearing shoes with a wide forefoot. A rubber band is placed over the bunions of both feet to separate them for exercise. An orthopedic brace may be worn at night to hold the bunions in a normal position. A silicone plug can be embedded in the bunion and 2 toes during the day. Usually this method is generally effective and does not stop the development of the bunion deformity. Surgical treatment: The majority of bunion patients require surgical treatment. A reasonable surgical approach is chosen based on the degree of bunion deformity, bone quality, and bone structure of the patient. The surgical treatment of bunions has been developed for more than 100 years. Up to now, there are more than 200 surgical procedures. The most commonly used are nearly 20 types. There are two schools of thought in China and two schools of thought abroad, but they are fundamentally different in operation. The former is divided into two schools: I. Small incision surgery for bigfoot: characterized by small incisions, fast recovery, and low cost. However, complications are high. Not every doctor can do it. Doctors who can perform small incision surgery generally have rich clinical experience and are known as masters within their peers. There are not many domestic doctors who can reach this level. General doctors operate with higher complications. Second, the European and American school: traditional surgery incision orthopedic + internal fixation, characterized by standardized operation, in line with the biomechanics of the foot, orthopedic results are reliable, internal fixation is secure. Few complications. You can walk on the ground after surgery (using special forefoot loading shoes), and the wound will heal in about 2 weeks, and you can move normally in about 1.5 months. The general foot and ankle specialist is capable of performing this procedure. The latter is also divided into small incisions and traditional surgery: foreign bunion research is more advanced than domestic research, so far the small incisions are only smaller, the actual operation is the same as traditional surgery, also with internal fixation. How to perform surgical treatment: First, the pathology of bunion is clarified: the first metatarsal bone is internally retracted with internal or external rotation and the metatarsal head is elevated; the bunion is externally deviated with rotation forward. There are various factors that contribute to this pathology, congenital anomalies – laxity of the ligaments. Excessive length of the first sequence of the bunion. Proximal metatarsal base abnormality-PASA abnormality. Acquired secondary: shoe wear, trauma, burns, etc. Patients with bunions can be divided into three main categories from the x-ray: 1) normal angle between the 1/2 metatarsals with bunion 2) increased angle between the 1 and 2 metatarsals with bunion 3) normal angle between the 1/2 metatarsals with forefoot metatarsal inversion The majority of patients seen in clinical practice are 2) and 3). First, we will analyze the first case: the cause of this bunion is due to two factors: one is the abnormal angle of the proximal phalanx PASA, and the second is the excessive length of the first sequence, which includes the excessive length of the proximal phalanx and the excessive length of the first metatarsal. The bunion occurs when the patient wears improper shoes (pointed shoes). The specific surgical procedure: wedge osteotomy of the proximal phalanx or shortening of the proximal phalanx. In case 2), this bunion type accounts for the majority of patients. The goal of surgery is to restore the 1/2 intermetatarsal angle without destroying the distal and proximal joints (except in special cases: severe metatarsophalangeal arthritis and laxity of the metatarsal cuneiform joint), because the 1st metatarsophalangeal joint is a hinge joint and the more the bunion deviates, the more the corresponding 1st metatarsal inversion. Patients with a 1/2 intermetatarsal angle <15 degrees and normal pasa and dmaa angles can be treated with a metatarsal neck osteotomy such as a chvron osteotomy + lateral soft tissue release and medial soft tissue tightening + adductor cut; if the pasa and dmaa angles are abnormally large, a modified reverdin or plus akin osteotomy can be used. In such patients with severe 2nd and 3rd metatarsalgia, a weil osteotomy may be added; if the 1st metatarsocuneiform joint is lax in the sagittal plane, the osteotomy may be a fusion of the 1st metatarsocuneiform joint. However, this is less common. < li=""> Patients with 1/2 intermetatarsal angle >15 degrees and normal PASA angle and DMAA angle can be treated with metatarsal cadres such as ludloff, basal cuneiform osteotomy, basal arc osteotomy, scarf osteotomy, etc. + lateral soft tissue release and medial soft group tightening + adductor cut; note that with basal osteotomy, the DMAA angle becomes progressively larger as the intermetatarsal angle is corrected. For patients with abnormal preoperative DMAA angle, be careful to correct the angle – Reverdin osteotomy. In such patients with severe 2nd and 3rd metatarsalgia, a Weil osteotomy may be added; if the 1st metatarsocuneiform joint is lax in the sagittal plane, osteotomy may be performed by fusion of the 1st metatarsocuneiform joint. Patients with a normal 1/2 intermetatarsal angle of <10 degrees but a bunion angle >15 degrees have a large PASA angle and can undergo soft tissue surgery to correct the PASA angle. However, if the patient’s forefoot adduction angle is too large, the surgery may be expanded, such as correcting the 2, 3, 4, and 5 metatarsal adduction. Of course, Scarf osteotomy is currently used abroad as the main surgical procedure for bunions, and good results have been obtained. Patients with a 1/2 intermetatarsal angle >15 degrees, for example, usually have a callus under the 2nd and 3rd metatarsal heads that is painful when walking. Such patients can have a modified Weil osteotomy for elevation of the 2nd and 3rd metatarsal heads. If a bunion patient has severe osteoarthritis of the 1st metatarsophalangeal joint, consider that pain relief after surgery is not particularly definite, and patients over 50 years of age with slightly more activity can be considered for arthrofusion; if patients over 65 years of age with less activity, consider Keller surgery; if older patients over 65 years of age with less activity but with higher quality of life requirements can be considered using arthroplasty. If the bunion patient has other toe deformities such as hammertoe, claw toe, etc., tendon release and transfer, arthroplasty, and joint fusion may be considered depending on the mobility of the interphalangeal joint (flexible, semi-rigid, rigid).